[Clinical evaluation of a new tonometer on the basis of international standard ISO 8612]. / Klinische Evaluierung eines neuen Tonometers auf der Basis des internationalen Standards für Augentonometer ISO 8612.

BACKGROUND: There is a continuous process of development of new tonometer types following different measurement principles on the tonometer market. A new tonometer working on the dynamic contour measurement principle is currently available for ophthalmologists. This device has special properties, since it determines the intraocular pressure as well as the ocular pulse amplitude. So far, clinical comparison measurements exist between the new tonometer Pascal and the applanation tonometer by Goldmann albeit without any reference to a standard. Besides, these measurements cover only a small pressure range between 7 mmHg and 23 mmHg which is not sufficient for medical diagnosis. PATIENTS AND METHODS: This new tonometer was investigated by clinical comparison measurements according to the currently valid international standard for human eye tonometers (ISO 8612). The tested tonometer determines the intraocular pressure without fluorescein. In an ophthalmogical hospital in Berlin the clinical comparison measurements were carried out by ophthalmologists on 127 patients according to the methods and criteria of the above-mentioned standard. A calibrated AT 870 from the Haag-Streit company served as reference tonometer. RESULTS: The different cornea surface geometries of individual eyes, the variation of tear liquid volume, and also the different elastic properties of the human eye due to a large variation in rigidity led to measurements of intraocular pressure by this tonometer with an excessively high number of outliers p (i) (i = 1, ..., 3) per group (p (1) = 16.28 %, p (2) = 8.85 %, p (3) = 15.69 %, 5.0 % outliers per group only are permitted for the differences method), which do not correspond to the requirements of the international standard for tonometers ISO 8612. This is also shown by application of total method of least squares of regression line (slope a = 0.964, interception b = 2.868 mmHg, standard deviation s (y) = 2.628 mmHg). CONCLUSIONS: The test of conformity of results of clinical comparison measurements to the international standard for tonometers ISO 8612 is the target of this work. The measurement results of the investigated tonometer are analysed and discussed according to this standard. Statements about the medical application of this medical measurement device for ophthalmologists are presented. According to the presented investigations the requirements of this international standard are not fulfilled by the tonometer Pascal.

[Results of cyclo-cryocoagulation of the ciliary body with probe temperatures of -70 degrees C and -82 degrees C in glaucoma]. / Ergebnisse der Zyklokryokoagulation des Ziliarkörpers mit Sondentemperaturen von -70 degrees C und -82 degrees C beim Glaukom.

Cryocoagulation of the ciliary body has few applications. Cryotherapy in our study was standardized: 8 applications, 4 mm posterior to the limbus, 55 s, 2.5-mm-diameter cryoprobe. The aim of this research was to optimize the method by comparing the side effects of the treatment and the results of 128 operations as seen at follow-up examinations. When an applicator at -70 degrees C had been used, 54% of 52 eyes showed an IOP < 21 mmHg 12 months after operation. In all cases and adjuvant therapy was necessary. The IOP in 73% of these eyes rose to 30 mmHg for short periods. It was necessary to reoperate in 39% of the whole group. When a cryoprobe at -82 degrees C had been used IOP was found to have normalized in 89% of 76 eyes. In this group 34% of cases needed no other therapy. The IOP in the treated eyes showed peaks up to 30 mmHg in 34%. We performed revision operations in 7.9%. It was only possible to normalize the IOP of hemorrhagic glaucoma and glaucoma connected with PEX by using -82 degrees C applicator. Examinations over 30 months after treatment show nearly the same results. Side effects of cryocoagulation of ciliary body were observed. Postoperative IOP peaks exceeding 55 mmHg were recorded in 10% of cases. These can be avoided by osmotic therapy. The anterior chamber was inflamed with exudation of fibrin in about 4% of patients treated with a -70 degrees C probe and 16% treated with one at -82 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Diphtheria among alcoholic urban adults. A decade of experience in Seattle.

Three outbreaks of Corynebacterium diphtheriae infection occurred in Seattle's Skid Road from 1972 through 1982. The first involved a single toxigenic, intermedius biotype clone, whereas the second and third outbreaks involved nontoxigenic mitis and gravis strains. Of 1100 total infections, 947 (86%) were cutaneous. The incidence was highest in winter and spring. In Skid Road, the estimated attack rate during 17 months in 1974 to 1975 was 5% for whites and 27% for native Americans. Streptococcus pyogenes was isolated from 73% of diphtheritic and 41% of nondiphtheritic skin lesions (P less than 0.001). Skin infection and environmental contamination by C. diphtheriae were correlated. Complications occurred in 21% of symptomatic nasopharyngeal and 3% of cutaneous toxigenic intermedius infections (P less than 0.001), and were significantly correlated with ages 60 years or more. Preferential use of erythromycin for diphtheria and pyodermas preceded plasmid-mediated resistance to erythromycin in C. diphtheriae. Diphtheria outbreaks in urban alcoholic persons are associated with poor hygiene, crowding, season, contaminated fomites, underlying skin disease, hyperendemic streptococcal pyoderma, and introduction of new strains from exogenous reservoirs.

The molecular epidemiology of three biotypes of Corynebacterium diphtheriae in the Seattle outbreak, 1972-1982.

Between 1972 and 1982 Seattle experienced a diphtheria outbreak involving 1,100 cases, primarily adults with cutaneous lesions. Biotyping revealed three consecutive overlapping outbreaks including 433 toxinogenic intermedius cases. Isolates from each quarter year were examined for DNA restriction fragment patterns and hybridization patterns with three DNA probes. All intermedius outbreak isolates appeared identical in all analyses and most stock cultures had the outbreak DNA fragment pattern, but DNA probes detected six patterns within 11 intermedius stock cultures. The mitis outbreak was heterogeneous, involving at least five restriction fragment patterns. In contrast, DNA restriction fragment analyses indicated that 22 of 25 gravis outbreak isolates belonged to a single strain, whereas there were seven strains within eight gravis stock cultures. DNA probe analyses of gravis outbreak isolates detected seven different patterns, five involving copy numbers of the toxB fragment and attB sites that presumably reflected lysogenic events that occurred during the outbreak.

[PGE1 in senile macular degeneration. A pilot study]. / PGE1 bei seniler Maculadegeneration. Pilot-Studie.

To determine whether PGE1 can improve retinal function a pilot study was carried out with seven patients (five women and two men) aged between 70 and 76 years who were suffering from a dry senile macular degeneration. The intravenous infusions of two ampoules of Prostavasion (PGE1) were given twice a day (infusion time: 2 hours per infusion) over three to five weeks (average four weeks). Retinal function was determined before and after treatment and finally again three months later one the basis of five criteria (subjective visual capacity, visual acuity, foveal threshold, static perimetry). The study showed that the subjective visual capacity had increased in six of the seven patients, the sensitivity of the foveal threshold in five, the average retinal sensitivity in two, and the average macular sensitivity in one. These results show that PGE1 probably has a therapeutic effect in the treatment of dry macular degeneration and that controlled studies make sense.

Antibodies to phenolic glycolipid-I during long-term therapy: serial measurements in individual patients.

Levels of IgM antibody to phenolic glycolipid-I (PGL-I) were measured in serum specimens collected over the initial 5 or more years of therapy from 11 leprosy patients. All three patients with paucibacillary disease had undetectable levels of antibody throughout their treatment. The eight patients with multibacillary disease had initially elevated levels which fell quite rapidly with treatment, reaching levels of 10% to 30% of their initial pre-treatment level after 5 years of therapy. The single patient with prolonged therapeutic noncompliance had an increase in antibody level, although clinical or bacteriologic relapse was not documented. These results in individual patients demonstrate that IgM antibody to PGL-I declines rapidly and consistently with treatment in multibacillary patients.

Treatment of chronic erythema nodosum leprosum with cyclosporine A produces clinical and immunohistologic remission.

We have treated three leprosy patients suffering from chronic, steroid-dependent erythema nodosum leprosum (ENL) with cyclosporine A (CsA). Excellent results were obtained in two patients. Extra-cutaneous manifestations of the reactional state were completely suppressed, and the development of new skin lesions was sharply curtailed. Immunohistologic abnormalities characteristic of active ENL were corrected. Lymphocyte subpopulations and anti-mycobacterial antibody levels in peripheral blood were unaffected. The third patient showed only a partial response to CsA, but satisfactory blood levels were never obtained in this individual because of dose-related gastrointestinal toxicity. The effectiveness of CsA in the treatment of ENL is consistent with the hypothesis that aberrant activation of a subset of T-helper cells is involved in the pathogenesis of this reaction. CsA may have a role in the treatment of chronic ENL that has failed to respond to conventional therapeutic modalities.

The limited spectrum of antinuclear antibodies in leprosy.

Sera from 46 consecutive patients with leprosy were collected and tested against an extensive panel of defined nuclear antigens. Antinuclear antibodies (ANA) were present in 16% of patients, but the titer was uniformly low and there was no consistent fluorescence pattern. None of the ANA positive sera contained antibodies which reacted with native DNA, or which were directed against histones, centromeres, SSB, Sm, or ribonucleoprotein. These more specific autoantibody assays thus retained their clinical utility in the differential diagnosis of rheumatologic complaints in patients with leprosy.

[Atraumatic needles for cataract surgery]. / Atraumatische Nadeln für die Kataraktchirurgie.

The author reports on his experience with spatula needles and cutting needles with micropoint in cataract surgery. Configuration and edge treatment of the different needles were demonstrated by scanning electron microscope. The characteristics of the tested needles seem to depend mainly upon their profile. In cataract surgery the spatula needles proved to be superior to the needles with cutting micropoint due to their ski-shaped design.

[Fibronectins: a possible treatment of therapy-resistant corneal ulcers]. / Fibronektin: Eine Behandlungsmöglichkeit therapieresistenter Hornhautulzera.

Fibronectin was isolated from a patient's plasma by affinity chromatography using gelatin-agarose. Biochemical and immunological tests proved the homogeneity of the fibronectin fraction. A therapy-resistant corneal ulcer following keratitis neuroparalytica was successfully treated with the isolated fibronectin. The ulcer healed within 26 days of fibronectin treatment (1 drop 6 X daily) and eight months have now passed without it recurring.

Zoster in the elderly: clinical, immunologic and therapeutic considerations.

Herpes zoster is common in the elderly. Persons over the age of 50 years have an attack rate double that of patients less than 50 years old. In the very aged, this rate nearly doubles again. The loss of cell-mediated immunity for the VZ virus appears to be the primary factor in the disruption of the dynamic containment process responsible for VZ virus latency within the sensory ganglion. Humoral immunity may play a role in the maintenance of latency, but the degree is unproven, except in the case of dissemination where loss of detectable antibodies seems to correlate with extradermatomal dissemination. Severe forms of the disease and its complications, e.g., postherpetic neuralgia, are likely among the elderly. Direct immunofluorescent staining or cytologic examination is useful for early diagnosis, and serologic changes can document the confusing clinical entity of zoster sine herpete.

Antibodies to mycobacterial arabinomannan in leprosy: correlation with reactional states and variation during treatment.

An enzyme-linked immunosorbent assay was used to measure antibody to mycobacterial arabinomannan in serial serum specimens obtained over the initial 12-31 months of therapy from nine patients with leprosy. The antibody level in pretreatment sera was directly proportional to the quantity of Mycobacterium leprae present in each patient as assessed by six-site scrapings (r = 0.75). The three patients with the lowest antibody levels (OD 0.1-0.3) had uncomplicated courses and their levels declined slowly with treatment. Three patients with intermediate antibody levels (OD 0.7-1.1) each experienced a reversal reaction during therapy; serial antibody titers in all three followed a triphasic pattern over the course of the reaction. The two patients who developed erythema nodosum leprosum during therapy had extremely high levels of antibody initially (OD greater than 1.5), which fell slowly with time and which were unaffected by the reactional state. The pretreatment antibody level to arabinomannan reflects the amount of M. leprae present and may have predictive value for the development of reactional states.

[Chlamydial disease of the eye: a report on 27 cases. Clinical picture, differential diagnosis, treatment (author's transl)]. / Chlamydienerkrankungen des Auges. Bericht über 27 Patienten, Klinik- Differentialdiagnose-Therapie.

During the past five years a presumptive diagnosis of ocular chlamydial disease has been made in 90 patients consulting the outpatient department of Freiburg University Eye Clinic. The diagnosis was confirmed by different methods (giemsa stains, chlamydia cultures and serology, electron microscopy and histology) in 27 cases. The clinical spectrum included inclusion blennorrhea in newborns as well as inclusion conjunctivitis, TRIC keratoconjunctivitis and sporadic trachoma in adults. Presumably the incidence of the disease is much higher than indicated by our figures. We suspect a very high number of undiagnosed cases. These patients usually do not receive proper therapy (tetracyclin or erythromycin for at least three weeks) and their disease may run a protracted course with the risk of permanent eye damage.

Effects of freezing on the corneal stroma of the rabbit after keratophakia.

In three rabbits a keratophakia as described by Barraquer (1972) was performed on both eyes, in one rabbit it was performed on one eye. In the right eye no cryoprotective agent was used, in the left eye the cryoprotective agent KM 26 was applied. Twelve hours after the operation, the majority of keratocytes in the tissue lens were destroyed. The nuclear chromatin was clumped, the cell membrane was destroyed and cytoplasm showed vacuolar alteration; cell organelles were no longer recognizable. After 24 h hardly any keratocytes were found. All corneae operated on with and without a cryoprotective agent, showed the same morphology. The cell debris was removed by macrophages, which could be found earlier in corneae operated on without cryoprotection. Three weeks after keratophakia no increase in the number of the residual keratocytes had occurred.

Identification of a basement membrane proteoglycan in exfoliation material.

We have used the indirect immunperoxidase technique to examine the exfoliation syndrome and can demonstrate that the fibrils so typically found in this disease certainly contain basement membrane proteoglycans. This finding is interesting for two reasons: 1. For the first time, an electron-microscopical technique is described that is able to identify one protein component of the exfoliation material. 2. The fact that the basement membrane proteoglycans are present in the exfoliation material supports the hypothesis that this disease is caused by a disturbance in the biosynthesis of the basement membrane.

Immunoelectronmicroscopical investigations on isolated collagen fibrils.

Isolated collagen fibrils treated with type-specific antibodies can be stained using a peroxidase-antibody complex. The staining pattern of the fibrils with this peroxidase-antibody complex is demonstrated and compared with the normal negative staining pattern of the fibrils. The possible binding sites of the anticollagen antibodies on the fibrils is also discussed.

[Orbital aspergillosis--a contribution to its diagnosis and treatment (author's transl)]. / Aspergillose der Orbita. Ein Beitrag zur Diagnostik und Therapie.

In connection with a case report, the mycological diagnosis and treatment of orbital aspergillosis are reviewed. In a 59-year-old male patient an exophthalmus on the right side could be diagnosed as aspergillosis spreading from the corresponding sinus maxillaris into retro- and peri-orbicular regions, after other causes had been excluded by differential diagnosis. In a biopsy specimen from the retrobulbar tumor, a fungal granuloma was found which, histologically and by isolation of the fungus, could be identified as an infection by A. fumigatus. Because of the good visus of the right eye, no exenteratio orbitae but an enoral revision of the sinus maxillaris, ethmoidal bone, and bottom of orbita was performed.--By infusions of amphotericin B and local washings with pimaricin (natamycin) in the sinus maxillaris and the region of the operation, a complete healing of the mycotic process was achieved.--Since 1 1/2 years, the patient has not had a relaps. This success of therapy was possible by exemplary cooperation of otorhinolaryngologists, ophthalmologists, pathologists and microbiologists.--In view of the prophylaxis of such infections, recent contributions to the epidemiology of aspergillosis are discussed.